Americans don’t often get “up close and personal” with their health insurance carriers.

We generally use email or snail mail to pay our premiums. And we usually resort to the telephone only when there’s a problem with a claim. For the most part, silence governs our relationships with the companies that pay our health care bills. 

Residents of affordable senior housing properties in Portland, OR, have a totally different relationship with at least one health plan in the state. 

These residents simply take the elevator to their building’s lobby when they want a face-to-face encounter with CareOregon, a not-for-profit health plan that serves more than 240,000 Oregonians and is the state’s largest Medicaid insurer.

Two CareOregon staff members -- a registered nurse and a certified medical assistant -- maintain regular hours at the housing properties each week. Standing behind lobby tables, they take blood pressure readings, answer health care-related questions, and connect residents with needed services and supports.

“We are trying to meet people where they are, in the most literal sense,” says Rose Englert, senior business leader of community health innovation programs at CareOregon. 

Residents don’t have to engage with the CareOregon staffers. And there’s no pressure to accept the help they offer.

“Residents have all the choice in the world,” says Englert. “We’re just trying to make it much easier for them to access resources in their homes, in their buildings, and in their neighborhood if they are interested.”

Housing With Services LLC

CareOregon isn’t alone in its outreach to residents of Portland’s affordable senior housing properties. The health plan is a partner and equity investor in Housing With Services, a limited liability corporation (LLC) established to coordinate the delivery of services and supports that a score of health, aging, and social services providers bring to 11 properties in downtown Portland.

Those properties are managed by the LLC’s three founding partners: Cedar Sinai Park, a LeadingAge member, Home Forward, and REACH Community Development. Other LLC partners include five community-based agencies that provide services in the buildings. Health care stakeholder partners include Providence Health Systems, and FamilyCare, one of Portland’s two accountable care organizations. The LLC also has interagency agreements with 15 additional service providers who provide services and supports to residents.

Equity investments from all the partners, and $1.5 million in grant funding received over the last 3 years, support the LLC. 

“It was not a huge investment,” says Englert about CareOregon’s buy-in to the venture. “We know it is going to take a while to get data about our outcomes. But CareOregon recognized that it takes some up-front investment to see some longer term savings.”

Health Literacy Translators

The CareOregon staff members working in the lobby of Portland’s senior housing properties are called “health navigators.” But they could just as easily be called “health literacy translators,” says Englert.

“They don’t provide care in the traditional sense of the word,” she says. “Instead, they use their medical knowledge to help residents understand how to use the nebulizer the doctor just prescribed, or how their new medicine is going to work with their other medications. Basically, they help folks follow their doctors’ instructions.” 

CareOregon clinical staff also works in the buildings to help residents transition home after a visit to the emergency department, or a stay in a hospital or nursing home.

“We actually go and visit with these residents to make sure have what they need to be able to stay at home through these transitions,” says Englert. 

Other CareOregon staff members manage a program called Food Rx, which delivers fresh produce to food pantries in the buildings. To date, the program has delivered more than 60,000 pounds of food to building residents. 

A program called Give2Get attempts to reduce isolation by creating opportunities for residents to socialize with one another and to volunteer either in groups or through peer-to-peer support. 

“Connecting people in this way has really increased the personal self-worth and value of people in the housing community,” says Englert. “It gives them the opportunity to feel needed and useful.”

Prime Motivation: Population Health

What drives a health plan to invest in a housing plus services model? For Englert, the answer is simple: population health models like the one implemented by Housing With Services LLC represent the future of health care.

“CareOregon recognizes that a large percentage of health is not about what happens in the doctor’s office,” says Englert, whose division focuses on addressing non-medical factors that affect the health status of CareOregon members. “We know that housing, isolation, and nutrition are the main barriers to health. We have understood this for a long time, but it has been hard to know what to do about it.”

Housing With Services LLC seemed to offer a good path forward, says Englert. 

“We wanted to learn, to understand what could work, and to be part of the messy, beautiful process that is involved in creating something innovative,” she says. “At the end of the day, we really want the Triple Aim of health care: getting better care to our population so that population is healthier -- and, hopefully, saving money along the way.”

Population health is at the heart of CareOregon’s mission, says Englert. That’s why the health plan decided to offer its navigator services to all interested residents, not just CareOregon members.

“If residents are our members, we can obviously do more for them because we know who their primary care physicians are and what their medical history is,” she says. “But even if residents are not CareOregon members, we have the resources to connect them to the help they need.”

The key to making these connections is the interdisciplinary team of health and service providers that work together through the LLC. If one agency can’t help a resident, that agency is expected to provide a referral and a formal handoff to another, more appropriate, agency. The LLC manages and provides oversight to the referral and care coordination process in order to ensure that residents do not fall through the cracks. 

Englert acknowledges that CareOregon’s not-for-profit status, and its mission to promote population health, makes it a good partner for the LLC. But she insists that similar partnerships can also fit the business models of for-profit health plans. 

“If we can pool our resources to support residents, we’re all going to realize better outcomes,” she says. “Residents will be healthier and they will be able to maintain stable, safe housing. We will all see an increase in the appropriate use of the health care system. And we’ll all see cost savings in the long run.” 

Getting Health Entities on Board

There’s a right way – and a wrong way – to go about convincing health entities to become partners in housing plus services models, says Englert.

“Housing providers often tell health plans, ‘You should fund what we’re doing. We’ll do all the work and when people are healthier, you will realize the savings,’” she says. “That lens is really understandable. The problem is that everybody else in the world is asking us for money too.”

Englert suggests several strategies that she believes would be more effective in sparking the interest of a prospective health partner.

Suggest a partnership, not a grant: “I find it very compelling when someone comes to us and says, ‘We would like to work in a partnership. We would like to share the learning. Let’s try this out together,’” says Englert. “Come in with that mindset of partnership. It is the relationships between the various parties that has been the engine for the LLC so far.”

Spell out the benefits: Health entities need to know exactly how they will benefit from a housing partnership, says Englert. Housing providers can promote several obvious benefits, including the fact that they know their residents well and can inform health plans (with a resident’s permission) about issues that don’t necessarily come to light during doctor appointments. Being able to conduct onsite wellness programs in a housing property where many members live is also “a huge thing” for a health entity, says Englert. 

But don’t stop there, she says. Get to know your potential partner and its particular needs. Then use a little creative thinking to identify additional incentives that could convince health entities to support your housing plus services program. Englert offers one example:

“As a health plan, CareOregon knows people who are experiencing certain issues because of homelessness or housing insecurity,” she says. “Could the housing property set aside units for our members? Or, could you give us some good contact information for transitional housing or housing case management?”

Be flexible: “You probably think you have a program that is pretty perfect, but let’s figure out how we can work together to build on it,” says Englert. “You need to be willing to change your program if it is not working, or to expand certain parts of the program that are working particularly well.”

Advice for Health Entities

Finally, Englert advises health plans and other health entities not to overthink their investment in housing plus services models.

“Just do it, especially if you are the kind of person who really likes figuring things out and creating real innovation,” says Englert.

You might even learn a thing or two along the way, she says.

“I have learned so much professionally about how to innovate, how to work in the housing space, how to work across different types of partnership,” says Englert. “It has really been a huge growth experience for our organization and for me personally. And it is just so much fun.” 

Geralyn Magan is a writer who resides in Clarksville, MD.